Medical Claim Analyst

Job not on LinkedIn

🔥 0 minutes ago

⚔️ Virginia, West Virginia – Remote

⚔️ Virginia – Remote ⛰️ West Virginia – Remote

💵 $18 - $31 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• Conduct initial review and triage of assigned claims and authorization requests • Verify member eligibility and benefits coverage • Identify and redirect misrouted claims or requests to the appropriate department • Prepare and process authorizations for clinical review by medical staff • Prioritize workload to meet regulatory requirements and turnaround time standards • Collaborate with internal and external stakeholders to support medical management activities • Perform non-clinical research and administrative support functions • Maintain accurate, complete, and timely documentation in accordance with company, regulatory, and accreditation standards • Protect the confidentiality of member information and comply with privacy and security policies • Investigate and assist in resolving claims payment issues • Support continuous improvement of service quality and member experience • Serve as a liaison between internal teams, healthcare providers, and external stakeholders to support medical management services and positive member outcomes

🎯 Requirements

• Excellent organizational, time management, and prioritization abilities • Basic knowledge of medical terminology and healthcare concepts • Proficiency with Microsoft Office applications, including Excel and Word • Ability to navigate multiple internal and external computer systems efficiently • Understanding of benefits administration and management • Understanding of claims processing and payment management • Understanding of claims policies and procedures • Understanding of general business operations • Understanding of clinical and medical management concepts • Critical thinking and sound decision-making skills • 2 to 4 years of experience in a medical assistant role, medical office administration, healthcare claims processing, utilization management, or authorization support preferred • Experience using CEC, HRP, Rumba, or MedCompass preferred • High School Diploma or GED required • Ability to protect confidential member information and comply with privacy and security policies

🏖️ Benefits

• CVS Health bonus, commission or short-term incentive program in addition to base pay • Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being, based on eligibility